The sugar industry and paying scientists

Anahad O’Connor at the New York Times – How the Sugar Industry Shifted Blame to Fat:

The documents show that a trade group called the Sugar Research Foundation, known today as the Sugar Association, paid three Harvard scientists the equivalent of about $50,000 in today’s dollars to publish a 1967 review of research on sugar, fat and heart disease. The studies used in the review were handpicked by the sugar group, and the article, which was published in the prestigious New England Journal of Medicine, minimized the link between sugar and heart health and cast aspersions on the role of saturated fat.

Even though the influence-peddling revealed in the documents dates back nearly 50 years, more recent reports show that the food industry has continued to influence nutrition science.

That last sentence is what gets me. This is going on right now, and has been going on for ages. It’s nothing new, and also it’s what happens in many other industries. Scientists are a little better regarding disclosures of funding now than 50 years ago, but industry is where a lot of research money comes from. An industry finds scientists who are either on their side of the issue or are sympathetic to their issue and funds their research.

What we need to do is to understand the biases and keep them in mind when making decisions on health policy.

Sugar is a drug?

German Lopez for Vox – The case for treating sugar like a dangerous drug, with an interview with Robert Lustig:

GL: Is that really grounds for considering it a controlled substance, though?

RL: There are four things that have to be met in order to consider a substance worthy of regulation. Number one: ubiquity — you can’t get rid of it, it’s everywhere. Number two: toxicity — it has to hurt you. Number three: abuse. Number four: externalities, which means it has a negative impact on society.

Sugar meets all four criteria, hands down. One, it’s ubiquitous — it’s everywhere, and it’s cheap. Two, as I mentioned, we have a dose threshold, and we are above it. Three, if it’s addictive, it’s abused. Four, how does your sugar consumption hurt me? Well, my employer has to pay $2,750 per employee for obesity management and medicine, whether I’m obese or not.

 

On Fat and Sugar

Jill Eisen for the CBC – Fat and Sugar, Part 1

First, fat was the dietary bad guy. We were warned back in the 1980s to cut back on eggs, meat and full-fat dairy to avoid heart disease. So we started eating more bread, rice and pasta and fat-free snacks. But we got sicker and fatter. Now sugar is the bad guy. Contributor Jill Eisen explores the complex, and sometimes contradictory, science of nutrition — and tries to find clarity amidst the thicket of studies and ambiguous research.

There’s also a great list of research references and a reading list at the link, for more information.

Part 2 airs on June 22, 2016.

Added sugar labelling!

That exclamation point is not an accident. I’m looking forward to this. From the FDA:

Today, the FDA has finalized the new Nutrition Facts label on packaged foods with changes that will make it easier for consumers to make informed choices about what they’re eating.

Some groups aren’t too happy with the change:

The Sugar Association is disappointed by the Food and Drug Administration’s (FDA) ruling to require an “added sugars” declaration and daily reference value (DRV) on the Nutrition Facts Label (NFL). The extraordinary contradictions and irregularities, as well as the lack of scientific justification in this rulemaking process are unprecedented for the FDA.

But the FDA says:

And you can have confidence in the science on which it is based, including evidence used to support the Dietary Guidelines for Americans, nutrition intake recommendations from the Institute of Medicine, and nutrition intake information from the National Health and Nutrition Examination Survey (NHANES).

Whose interpretation of science is correct? Well, the Sugar Association is likely a little biased.

Fat vs sugar

Ian Leslie at the guardian – The sugar conspiracy:

The UN’s Food and Agriculture Organisation, in a 2008 analysis of all studies of the low-fat diet, found “no probable or convincing evidence” that a high level of dietary fat causes heart disease or cancer. Another landmark review, published in 2010, in the American Society for Nutrition, and authored by, among others, Ronald Krauss, a highly respected researcher and physician at the University of California, stated “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD [coronary heart disease and cardiovascular disease]”.

Many nutritionists refused to accept these conclusions. The journal that published Krauss’s review, wary of outrage among its readers, prefaced it with a rebuttal by a former right-hand man of Ancel Keys, which implied that since Krauss’s findings contradicted every national and international dietary recommendation, they must be flawed. The circular logic is symptomatic of a field with an unusually high propensity for ignoring evidence that does not fit its conventional wisdom.

Sugars in children’s fruit juices and smoothies

A study published in the BMJ by Boulton and Hashem et al – How much sugar is hidden in drinks marketed to children? A survey of fruit juices, juice drinks and smoothies:

The difference between whole fruit and fruit juice:

One key difference between whole fruit and juice is fibre content. Whole fruit slows down consumption and has a satiating effect. Research shows the body metabolises fruit juice in a different way compared to whole fruit. After whole fruit consumption, the body seems to adjust its subsequent energy intake appropriately, whereas after fruit juice consumption, the body does not compensate for the energy intake.

And the conclusion? (formatted for readability)

The sugars content in FJJDS marketed to children in the UK is high. Over 40% of products surveyed contained at least 19 g of sugars—a child’s entire maximum daily amount of free sugars.

-We suggest that FJJDS with high free sugars content should not count as one of the UK government’s ‘5 a Day’ recommendations.
-Ideally, fruit should be consumed in its whole form, not as juice.
-Parents should dilute fruit juice with water, opt for unsweetened juices and only give them during meals. -Portions should be limited to 150 ml a day.
-In order to help combat the growing problem of childhood obesity, manufacturers need to stop adding unnecessary sugars and calories to their FJJDS now; otherwise, it will be essential for the government to introduce legislation to regulate the free sugars content of these products.

Canadian Senate Report on Obesity – on sugars

From page 6 of the report:

Sandra Marsden of the Canadian Sugar Institute testified that sugar consumption has declined in recent years, however, as that organization represent the sucrose industry (the sugar extracted from beet and sugar cane), this decline seems to be only associated with sucrose and not all sugars combined.

(Zing!)

The Canadian Sugar Institute says the estimated added sugars* consumption in Canada is approximately 51 – 53 g per day.

A number of witnesses also told the committee that sugary beverages are the primary source of added sugar in our diet and are the primary driver of obesity. They noted that these beverages have little or no nutrient value while being calorie-rich. Further they indicated that these are ‘invisible’ calories as they do not contribute to satiety and are simply added calories over and above food intake. Some witnesses offered testimony that sugar is addictive and that it promotes overconsumption.

Addictive? Interesting.

From page 12 of the report:

At the same time, Manuel Arango, of the Heart and Stroke Foundation of Canada, indicated that as much as 62% of the Canadian diet can be categorized as highly-processed, a percentage that has been rising in recent decades at the expense of whole foods. As a consequence of the increased intake of highly processed foods, sugar consumption has increased dramatically from 4 bounds annually per person 200 years ago to 151 pounds annually per person today.

151 pounds per person is huge. That’s nearly 1 cup of sugar per day. I’m not sure where they get that figure.

The Heart and Stroke Foundation of Canada’s position statement on sugar cites that total sugar intake is 110 g per day, or about 1/2 cup per day.

As mentioned previously, Health Canada’s proposed limit is 100 g per day of total sugars.

Footnotes:
*"Added sugars" is defined as follows:

Sugars and syrups (Statistics Canada Category - Sugar and sugar syrups (from sugar cane or sugar beets), maple sugars, honey. Does not include corn sweeteners.
Corn sweeteners: high fructose corn syrup ("glucose-fructose"), glucose syrup, and dextrose.
Fruit juce/concentrated fruit juice or other ingredients that act as a functional substitute for added sugars.

 

Recommended daily intake of sugars

After reading about the recently released 2015 USDA dietary guidelines (and the controversy surrounding it) I was wondering what the recommended maximum daily intake of sugars was, given those guidelines don’t state a maximum, and neither does the Canada Food Guide. Here’s what I’ve found.

The WHO recommends a daily limit of about 13 teaspoons of added sugars per day

The WHO published guidelines in 2015 on Sugars intake for adults and children, which recommended the following:

  • WHO recommends a reduced intake of free sugars throughout the lifecourse (strong recommendation*)
  • In bnoth adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake (strong recommendation*)
  • WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation**)

Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Notes:
* Strong recommendations indicate that "the desirable effects of adherence to the recommendation outweigh the undesirable consequences". This means that "the recommendation can be adopted as policy in most situations.
** Conditional recommendations are made when there is less certainty "about the balance between the benefits and harms or disadvantages of implementing a recommendation". This means that "policy-making will require substantial debate and involvement of various stakeholders" for translating them into action.

Free sugars do not include the sugars already present in whole foods such as fruit and vegetables.

For a 2000 calorie diet, they recommend that 200 calories come from these free sugars. What is 200 calories in terms of, say, granulated sugar? Based on the USDA Nutrient Database, granulated sugar has 387 calories per 100 g of sugar. So 200 calories is 51.7 g of sugar. Put another way, that’s just about 13 teaspoons of sugar per day (at 4 g per teaspoon of sugar).

As stated above, they further propose that the daily limit be reduced to 5% of total energy intake, so going back to our 2000 calorie diet, that’s 100 calories, or 25.8 g, or 6.5 teaspoons per day. The caveat is that there is less certainty about the benefits from recommending an even lower sugar intake amount.

Health Canada’s proposed daily sugar limit

Currently, Canada’s Food guide doesn’t give a limit for sugar. In June 2015, Health Canada published a set of proposed regulations to amend the nutrition labeling of food products (among other labeling changes). In the proposed regulations, a sugar limit is given:

A DV of 100 g is being proposed for sugar, and the declaration of the % DV for sugar in the NFt would be mandated for all foods. Consumers would be able to use the % DV to determine whether a food contains a lot or a little sugar (as indicated by the rule of thumb footnote), and as a result adjust or limit their sugar intake.

The “% DV” is the daily value amount, based on the recommended daily intake chart (near the bottom of the page).

The proposed 100 g of sugar recommended here is about double the recommendation from the WHO; however, that’s total daily intake, from added and natural sugars. The WHO recommendations only dictate limits on added sugars to foods.

Proposed sugar limit and % DV

I advocate for a 50 g daily intake limit for added sugars. The nutrition labeling should also reflect this 50 g limit and corresponding % DV for sugar. Added sugars are more of a concern than naturally occurring sugars in vegetables and fruit, and nutrition labeling is generally on processed foods – where the added sugars are. However, it should be clear in the guidance documentation that overall limit is 100 g of sugar per day.